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Strength, determination and hope - defining our humanity

      More than 18 months into the global COVID-19 pandemic, we continue to adjust to the rapid contraction or expansion of usual activities and physical interaction depending on the current public health recommendations. Prevalence of disease is one measure of the impact of the pandemic, which for many of us has personal significance, with friends and loved ones affected by COVID-19. Another measure of impact is the socio-cultural effects that have arisen, with the necessary separation of people, in an effort to minimise the spread of disease; undertaken through mechanisms such as lock-downs, travel restrictions and mandatory quarantine. Arguably, these impacts have been experienced most acutely during periods of traditional ritual or rites of passage such as births and deaths. For those of us working with families during childbearing this has been especially evident. The public health measures that have required separation of people during the unique time of childbearing has resulted in profound impacts both to those giving birth and to those providing care.
      The significance of the socio-cultural impacts are evident as we look to countries like New Zealand and Australia, where despite comparatively reduced disease burden – the impacts of changes to maternity care on women and their families is ever-apparent. We’ve recently completed the largest national study of the experiences of receiving and providing care during the COVID-19 pandemic in Australia. The levels of maternity service disruption have been significant and have impacted all people mostly negatively but some positively.
      Women reported they have felt alone and distanced by the reduction in face to face services but also fearful of visiting hospitals for appointments because of the potential for exposure to COVID-19 [
      • Sweet L.
      • Bradfield Z.
      • Vasilevski V.
      • Wynter K.
      • Hauck Y.
      • Kuliukas L.
      • et al.
      Becoming a mother in the ‘new’ social world in Australia during the first wave of the COVID-19 pandemic.
      ]. The rapid changes have led to an increase in women seeking continuity of care and birth outside of hospital with increased demand for access to birth centres and homebirth [
      • Wilson A.N.
      • Sweet L.
      • Vasilevski V.
      • Hauck Y.
      • Wynter K.
      • Kuliukas L.
      • et al.
      Australian women’s experiences of receiving maternity care during the COVID-19 pandemic: A cross-sectional national survey.
      ]. Women’s partners and support people have struggled with the separation caused by no or limited visitation rights in antenatal appointments, during labour and in the postnatal period. The significant and important role of offering support during pregnancy, birth and in new parenting has been radically altered in a very short space of time [
      • Vasilevski V.
      • Sweet L.
      • Bradfield Z.
      • Wilson A.N.
      • Hauck Y.
      • Kuliukas L.
      • et al.
      Receiving maternity care during the COVID-19 pandemic: Experiences of women’s partners and support persons.
      ].
      Health professionals have also struggled with the many changes, which at some points have occurred hourly in response to information updates. Separation from women has offered new challenges to providing quality care in socially- distanced, shortened visits wearing heavy and uncomfortable personal protection equipment (PPE) or via telehealth [
      • Bradfield Z.
      • Hauck Y.
      • Homer C.S.E.
      • Sweet L.
      • Wilson A.N.
      • Szabo R.A.
      • et al.
      Midwives’ experiences of providing maternity care during the COVID-19 pandemic in Australia.
      ,
      • Szabo R.A.
      • Wilson A.N.
      • Homer C.
      • Vasilevski V.
      • Sweet L.
      • Wynter K.
      • et al.
      Covid-19 changes to maternity care: Experiences of Australian doctors.
      ]. As maternity providers, we have carried the burden and worry of potentially missing key assessment and care practices because of the changes and being unable to provide the support and personal touch that we know is so important. Midwifery students too, described the expendability they experienced with clinical placements widely discontinued impacting their course progression and ability to provide continuity of carer with women as agreed [
      • Kuliukas L.
      • Hauck Y.
      • Sweet L.
      • Vasilevski V.
      • Homer C.
      • Wynter K.
      • et al.
      A Cross Sectional Study of Midwifery Students’ Experiences of COVID-19: Uncertainty and Expendability.
      ].
      Despite all of the challenges, we have also borne witness to the most incredible testaments of human resilience and strength in the face of hardship. Many new parents described reduced hospital visitation enabled them to focus on developing new parenting skills and bonding with their baby [
      • Wilson A.N.
      • Sweet L.
      • Vasilevski V.
      • Hauck Y.
      • Wynter K.
      • Kuliukas L.
      • et al.
      Australian women’s experiences of receiving maternity care during the COVID-19 pandemic: A cross-sectional national survey.
      ]. Some also found telehealth care convenient, particularly those with young children or who live in rural areas [
      • Sweet L.
      • Bradfield Z.
      • Vasilevski V.
      • Wynter K.
      • Hauck Y.
      • Kuliukas L.
      • et al.
      Becoming a mother in the ‘new’ social world in Australia during the first wave of the COVID-19 pandemic.
      ]. As antenatal education has moved to online, partners felt some relief at being able to access education to help them support their pregnant partner [
      • Vasilevski V.
      • Sweet L.
      • Bradfield Z.
      • Wilson A.N.
      • Hauck Y.
      • Kuliukas L.
      • et al.
      Receiving maternity care during the COVID-19 pandemic: Experiences of women’s partners and support persons.
      ]. Midwives working in continuity models have described the protective effect of midwifery continuity of care, both for the women receiving the care but also for themselves. The trusting professional relationship offered a buffer and reduced anxiety for both women and midwives as they could keep in contact and up to date with the rapid changes [
      • Bradfield Z.
      • Hauck Y.
      • Homer C.S.E.
      • Sweet L.
      • Wilson A.N.
      • Szabo R.A.
      • et al.
      Midwives’ experiences of providing maternity care during the COVID-19 pandemic in Australia.
      ]. Doctors have also described that the reduced hospital visitation rules made clinical care easier and seemed to be well-received by most women [
      • Szabo R.A.
      • Wilson A.N.
      • Homer C.
      • Vasilevski V.
      • Sweet L.
      • Wynter K.
      • et al.
      Covid-19 changes to maternity care: Experiences of Australian doctors.
      ]. It is encouraging to see that midwifery students have increasingly been included and rightly recognised as our future workforce.
      As we have begun to build evidence about what happens to the humans that are impacted by maternity service delivery changes as a result of the pandemic, we have a deeper understanding of how we can undertake redesign for future maternity services planning. There is broad agreement that a return to pre-COVID service provision should not be the goal but rather we should find the determination to “build back better and fairer” with humane, evidence-based improvements to meet the needs of women and their families in a way that sustains our health professionals [
      • Bradfield Z.
      • Wynter K.
      • Hauck Y.
      • Vasilevski V.
      • Kuliukas L.
      • Wilson A.N.
      • et al.
      Experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia: A five-cohort cross-sectional comparison.
      ].
      The next step is to embrace our newest challenge. Evidence shows that pregnant women with COVID-19 infection are at increased risk for admission to hospital, more likely to need ventilation and have a higher risk of stillbirth. Health professionals in Australia have received prioritised access to COVID-19 vaccination and recently, the national guidelines have recommended pregnant people should be vaccinated [

      ATAGI. Clinical guidance on use of COVID-19 vaccine in Australia in 2021 (v4.0). Australian Technical Advisory Group on Immunisation (ATAGI): Australian Technical Advisory Group on Immunisation (ATAGI).

      ]. We have conducted a study to explore the COVID-19 vaccination intentions and perceptions of those receiving or providing maternity care in Australia. Findings show that there is work that needs to be done to provide health professionals, women and their families’ access to evidence-based health information to support their decision making. Midwives are a key part of the international public health clinical workforce who, if activated and resourced offer a significant source of genuine evidence-based hope for better outcomes for women and their families. Our privileged role is to present the national recommendations regarding vaccination against COVID-19 which has never been more important. To support this, there is an urgent need for resources to facilitate conversations between health professionals and people of childbearing age, specifically pregnant women to provide education and recommendations that are in line with national guidelines. We are capable of approaching this next challenge with the resilience and innovation that has been shown during the first and then subsequent waves of the pandemic, finding new ways to work together and demonstrate that we indeed are a robust and magnificent species.

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        Australian women’s experiences of receiving maternity care during the COVID-19 pandemic: A cross-sectional national survey.
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        Receiving maternity care during the COVID-19 pandemic: Experiences of women’s partners and support persons.
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        Covid-19 changes to maternity care: Experiences of Australian doctors.
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      1. ATAGI. Clinical guidance on use of COVID-19 vaccine in Australia in 2021 (v4.0). Australian Technical Advisory Group on Immunisation (ATAGI): Australian Technical Advisory Group on Immunisation (ATAGI).